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Reproductive > Urinary Incontinence or Retention > Flashcards

Urinary Incontinence or Retention Flashcards

1
Q

beta 3 in the bladder

A

relaxes detrussor

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2
Q

alpha 1 in the internal sphincter

A

contracts urethral smooth muscle

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3
Q

sympathetic nerve int he micturation pathway

A

Hypogastric (t10-12)

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4
Q

external sphincter under control of

A

Pudendal nerve-ACH onto nicotinic receptors causes contraction

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5
Q

urine storage path

A

LOW level vesical firing–SNS outflow of Hypogastric (to IUS and Detrussor)–Somatic (pudendal) to EUS–GUARDING/ CONTINENCE reflexes–inhibits detrussor muscle contractility

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6
Q

Voiding Path

A

BLADDER FIRING INTENSELY in afferent pelvic nerve–activates spinobulbosal reflex arc–to Pontine MicCtr–PNS to bladder and sphincter-inhibits Pudendal (somatic) and SNS outflow

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7
Q

SNS and SOmatic inhibited

A

Voiding Phase

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8
Q

SNS (hypogastric) to IUS and Detrussor and Somatic (Pudendal) to EUS are very active

A

storage phase…this is continence

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9
Q

First line therapy usually after behavioral modification

A

Antimuscarinic meds, tolteridine, oxybutinin

*not without major adverse effects

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10
Q

problem with anticholinergics especially in elderly population

A

-drug drug interactions

>cognitive impairment

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11
Q

urge in continence seen in what patients

A

BPH with overflow
Alzheimers
parkinsons
Strokes

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12
Q

tx of urge incontinence

A

Anticholinergics
oxybutinin
tolterodine

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13
Q

urge incintinence will present how?

A

urgency and frequency, day and nocturia

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14
Q

stress incontinence will present how?

A

minimal urine loss with sneezing or laughing

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15
Q

tx of stress incontienence

A

topical E
Alpha agaonist
non-pharm methods

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16
Q

cause of atonic bladder

*complete loss of bladder control

A

severe DM neuro3pathy

stroke

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17
Q

Tx for atonic bladder

A

catheter

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18
Q

muscarinic rceptors on the bladder

A

m2 and m3

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19
Q

M2 in the bladder does what

A

opposes beta adrenergic receptors-indirect effect on bladder muscle

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20
Q

M3 in bladder does what

A

direct effect on contracting smooth detrussor muscle of bladder

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21
Q

blockade of M2/M3 results in

A

retnetion,
decreased contraction
(unopposed beta stimulation of IUS/detrussor

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22
Q

Colinergic excess

A 
Diarrhea (and Diaphoresis) and abdominal cramping
Urination
Miosis (pinpoint pupils)
Bradycardia (muscarinic) or 
Emesis (Nausea and Vomiting)
Lacrimation
Lethargy
Salivation
*therfore anticholinergics have the oposite effects of all these
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23
Q

quaternary amine that does not cross BBB

A

Trospium-less central adverse effects

24
Q

only anti-cholinergic agent that does not undergo hepativ metabolism to less active drugs

A

trospium

25
Q

drug with no urinary excretion-rapidly hydrolyzed to 5 hydroxymethyl-tolteridine

A

fesoterodine

parental drug not detectable in systemic circulation

26
Q

drugs available in ER bc they have shitty duration of effect

A

oxybutinin and tolteridine

27
Q

longest half life

A

solifenacin

vesicare

28
Q

poorly bioavailable

A

Oxybutinin
trospium
darifenacin

29
Q

contraindication for Anticholinergics

A

URINARY/GASTRIC OBSTRUCITON
NEED FOR MENTAL ALERTNESS
ALZHEIMERS DIMENTIA
ANGLE CLOSURE OR NARROW ANGLE GLAUCOMA

30
Q

ISSUE FOR PATIENT COMING OFF ANTIMUSCARINIC DRUGS IS

A

INTOLERABLE DRY MOUTH

31
Q

BOTOX BETTER FOR..

A

PATIENTS WHO RESPONDED TO ANTICHOLINERGIC THERAPY BUT FOUND THE DRUGS SIDE EFFECTS INTOLERABLE

32
Q

BOTOX MOA

A

inhibits vesicular release of escitatory NT’s and axonal expression of the SNARE-complex dependent protiens or psinal reflexes thought to cause detrussor overactivity

33
Q

inhibits expression of purinergic (P2X) and proposed SP receptors-thus changes the phenotype of urothelial cells

A

Botox

34
Q

immediate effect is peripheral affarent desensitization

A

Botox

35
Q

during urine storage, BOTOX….

A

blockes excitatotyr effect on sub-urothelial afferent and detrussor PNS nerve endings during storage phase

36
Q

beta-3 receptor activation causes

A

relaxation of detrussor smooth muscle

37
Q

alpha 1 activation causes

A

constriction of IUS smooth muscle

38
Q

Beta 3 agonist

A

mirabegron

*increases baldder capacity by relaxing detrussor S.M.

39
Q

direct and indirect alpha and beta agonist
Alpha >beta effects
(constrictive>relaxing)

A

Pseudoephedrine

*off label

40
Q

Indirect non-selective alpha and beta

A

Ephedra, Ma-Huang

41
Q

For Sympathomimetics–> longest half life, poorest oral bio availability, most CYP metabolism, least urinary excretion,

A

Mirabegron

42
Q

elimination is accelerated in the presence of acidic urine

A

Pseudo ephedrine

  • Ma-Huang
  • Ephedra
43
Q

issue with Mirabegron

A

HTN

tachycardia

44
Q

issues is pseudo ephedrine

A

HTN, Tachycardia, A-fib
insomnia
anxiety, nervousness, restlessness

45
Q

Ephedra issues

A

HTN, TAchyarrythmia, CHF, MI, Insomnia, CNC sitmulaiton symptoms

46
Q

all sympathomimetics should be cautioned with

A

concurrent MAOI use

47
Q

Reduces odor emanating from leaked urine

*and to counter dermatitis from leaked urine

A

methionine

*ammonia free urine by acidifying urine pH

48
Q

used in patients with intrinsice sphincter dysfunction

A

bovine collagen

49
Q

increases tissue bulk around uretheral lumen

A

bovine collagen

50
Q

Drugs classes to treat urinary retention and overall goal

A

to increase cholinergic stimulation of detrusor muscle contraction

  1. muscarinic agonist
  2. acetylcholinesterase inhibitor
51
Q

Muscarinic agonist to tx. urinary retention

A

Bethanechol

*does NOT cross BBB

52
Q

acetlycholinesterase inhibitor for urinary retention

A

neostigimine

53
Q

inactviated by cholinesterases and hepatic microsomal enzymes

A

neostigimine only

54
Q

can increase ACH onto Nicotinic and Muscarinic receptors

A

Neostigimine

*Bethanecol only acts on stimulating Muscarinic receptors only

55
Q

Urinary retention rug with major heart/hemodynamic/rhythm side effects

A

Neostigimine
gives the acetylcholine excess picture
AV block, Bradyarryhtmia, hypotension, tachycardia

56
Q

bethanecol issue

A

lightheaded, syncope, urinary urgency, excess tears, dizziness

57
Q

opiates and urinary control

A

detrussor relaxation

Reproductive (9 decks)

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